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Show . '0 Gl > t. Q) Ill t. Gl -'0 0 Ill .s: () .s: ~ c .I..l,l c Gl -E bll .G.l '0 c Ill Ill G) c Ill Q. E 0 () .I .I II( Q) ·>- " Form 2970. APPLICATION OF MOTHER FOR ARREARS OF PAY, ETC. S T .11 TE 0 F -----------------------------------------------------------------, County of -------------------·---------------------------------, 88: Personally appeared before me, a ------------------------------------ in and for the County and State aforesaid, _________ ---------_________________________________________________________ , of ___________________________________________________ , in the County of ---------------------------·--------------------------- and State of -------------------------------------------------------, aged ------------------------------------------------------ years, who, being duly sworn, declares that she is the mother of ------------------------------------------------------------------------------------, who was a ------------------------------------ in Company ____________ , ------------ Regiment ------------------------------------, ------~-------------------------------------------- ----------------- -------~---------------------------------= ---------------- ---------------- ------------- --------------- -------------------- -------- ____________________________________ : ______________ ; that this soldier was born at __________________________________________ , in the State of---------------------------------------------, on the __________________ day of ___________________________ , L _____ ___ ; that he died on or about the ------------------ day of ______________________________ , L ________ , at --------------------------------------- ------------------------------------------------' leaving neither wife nor child. His father, ------------------------------------------------:--------------, died on or about the --------------------- day of ______________________________ , L ________ , at ------------------------------------------------------------------, (or if living) resides at ------------------------------------------------------, and that he ------------~-------- abandoned the support of his family. (tNSERT HAS, OR HAS NOT.) This application is made to recover all arrears of pay and allowances (including bounty) due from the United States . ________________________________________________________________________________________________ ----· ·-____________________ _ Her post-office address 1s WITNESSED BY- (SPECIFY A NY OTHER ITEMS C LAIME D.) -----------------------------__ ._ --------------------------------------------------------------------------- I ~i~~U:%. of}-~------------------------------------------------------------- Also personally appeared before me ---,.- -------------------------------------------------------------------------------- and -------------------------------_________________ __________________ , of the County of -------------------___________ ------------------------ and State of _________________________________ ____________________________________ , who, being duly sworn, declare that they have been for ------------------------------------ years acquainted with the above-named applicant, and with said -------------------------------------------------------------------__ ___ , deceased, 'vho was a ------------------------____ ______ __ _ in Company ____________ , ____________ Regiment _________ __ _________________________ , ---------------------------------------------------- ----------------------------------------------------------------------------------------------- and know said applicant to be the mother of said deceased, and that said deceased left neither wife nor child. His father, ------------------------------------------- --------------------1 died on or about the --------------------- day of ____________________________________ , L _____ ___ , at ___ _________________________________________________________ , (or if living) r esides at ______________________________________________________ , and that he --------------------- abandoned the support of his family; (t NSERT HAS. OR HAS NOT.) that they have no interest whatever in this application, and their post-office address is ------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------------- WITNESSED BY-s~~ f l: l :_:::::::::::::::-::::_:::::::::::::::_:-____ ::::::::: Sworn to and subscribed before me, this ------------------ day of ------------------------------------1 19 _____ _ (SEAL.) 0 fficial signature: -~ --------------------- _______________ -------------- ______________ -· :&--3729 |
